Revisiting EBP benefits

Now that the mandatory health insurance policies in Dubai, introduced from 1 January 2017, are due for renewal from 1 January 2018, let’s revisit some of the important features.

The compulsory health insurance is essential basic cover package (EBP) covering all those earning under AED4,000 per month, irrespective of their age or condition. EBP includes outpatient consultancy at clinics, referrals to specialist and for surgical and pathology investigations, maternity health cover, emergency visit to hospital and any surgery required as well as medications.

Employers have group insurance schemes for their employees. However, residents should go for a tailor-made cover for his dependents including spouse, minors and domestic house help.

The beneficiary with basic insurance cover gets a maximum coverage of up to AED150,000, in cases where the insured requires prolonged hospitalisation. However, there is a special protection package under the EBP scheme. This package mandates that although a beneficiary has to pay a minimum of 20 per cent of co-insurance payment in case of a hospital stay or surgery, it is capped at AED500. This means that if the insured has a major surgery costing AED40,000, even those in the basic package would be expected to pay AED8,000 as 20 per cent. But the protection package mandates a ceiling of AED500 and a maximum payment of AED1,000 in the whole year. Co-Insurance is the percentage of the bill that the policyholder has to bear. In the basic package, this has been fixed at 20 per cent, which means if the policyholder visits a doctor and gets a bill of AED100, he will have to pay AED20 from his pocket.

In the case of the EBP, all those who come under its purview for the first time cannot get coverage for pre-existing illnesses for the first six months. But if he or she has a chronic condition that has been declared, it will be mandatorily covered after six months. All declared chronic illnesses will be mandatorily covered even when the holder transfers to another insurance provider.

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